OPHTE# Harnett County Department of Public Health 21232
PERMIT # a 51~ I Operation Permit
New Installation X Septic Tank El Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: S+La2p, t rza ly
Name: (owner) S,.ipw ~oNS~CLUL~IOs~J SUBDIVISION S,Ulzp Vt,,y,CE LOT # Li-7
System Installer: Cr--ar r-o ar t Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t d O feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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North Larohna beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ( Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch t'}b feet
French Drain Reouired: \ r`i~rt
Septic Tank: IybC~ gallons Pump Tank: gallons
width of depth of
ditches feet ditches 12-30 inches
Authorized State Agent q A5 Date t 11
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